According to The Boston Globe, a 2011 report estimated that Russians were drinking, on average, about 4 gallons of pure alcohol per year—which is about 70 percent more than Americans. In 2009, the British medical journal The Lancet estimated that more than half of all Russians dying between the ages of 15 and 54 were dying from excessive drinking, and more than half the children in a typical Russian orphanage suffer from fetal alcohol syndrome.

As an American, you might think Russia is a country that needs Alcoholics Anonymous, “a recovery movement built around a long, sustained support process that attacks addiction at its core and teaches people how to live a sober life.” But treatment for alcohol abuse looks very different in Russia than it does in the United States, reports The Boston Globe. It typically involves a single doctor visit during which patients go through a round of detox before being hypnotized and given a prescription for anti-drinking pills.

To Americans, this may sound like a short-term solution, one that is not likely to cure alcoholism. But it’s not easy to transport an idea that originated in one country to work in another, very different one. The reasons why Russians are so resistant to a program like AA are multiple and complex:

The most important, perhaps, is that the Russian idea of “alcoholism” is very different from the American one: According to medical anthropologist Eugene Raikhel, the popular definition of a “drinking problem” in Russia is what happens at “the endpoint of chronic alcohol use,” not the drinking itself, which is considered perfectly normal.

The more concrete explanation? Political scientist Mark Schrad argues that drinking became a fixture of Russian life “because the state profited from it—both in a financial sense, by way of a monopoly on the production and sale of alcohol, and a political one, in that drunk people are easier to govern.“

And no Russian believes the “anonymous” part of AA. A psychiatrist who conducted a pilot study of AA in 2007 in the city of Voronezh, said he hears the same thing from his patients whenever he suggests they attend a meeting. “Nobody believes in anonymity. Nobody believes it, and people are afraid to be recognized.”

Even those who utterly destroy their lives through drinking tend to be regarded with understanding and sympathy: “A drunk man,” said Yanni Kotsonis, a Russian historian at New York University, “invites the pity and support of the community.” For Kotsonis, the idea of AA flourishing in Russia is a nonstarter until this attitude changes: “My sense is it cannot take root because of the general understanding that drinking alcohol is not wrong,” he said.

All of these reasons contribute to the fact that, to this day, the number of AA meetings being held in major Russian cities and provinces is “wildly out of proportion” to the number of alcoholics who live there.